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Challenges presented by nerve damage in leprosy.
Lepr Rev. 2005 Mar; 76(1):5-13.LR

Abstract

The basis of nerve damage in leprosy is the unique tendency of Mycobacterium leprae to invade Schwann cells. alphaBeta-Dystroglycan on the basement membrane of Schwann cells binds to laminin alpha2, in turn binding to receptors on the M. leprae surface, comprising a histone-like protein and phenoglycolipid-1. When nerve damage during reversal reactions was found to be associated with an abrupt increase in delayed type hypersensitivity against M. leprae antigenic determinants released from Schwann cells, it suggested that the nerve is damaged as an innocent bystander during the immune response. This strongly influenced the introduction of therapy based on immunosuppression combined with continued anti-mycobacterial medication. Lysis of Schwann cells presenting M. leprae antigenic determinants by activated CD4+ T cells and interaction of M. leprae with Toll-like receptors on Schwann cells are additional mechanisms implicated in nerve damage. Persistence of M. leprae antigen in local lesions after regular multiple drug therapy (MDT) is an important risk factor for late reactions. In spite of significant advances in the provision of MDT globally, early diagnosis, together with effective treatment of the disease and associated nerve damage at initial presentation remains a major challenge for the health services. Reduced prevalence as a result of MDT should not be taken to indicate that the challenges of leprosy control are diminished as long as nerve damage is not controlled and new case detection rates are not declining.

Authors+Show Affiliations

Institute of Immunology, University of Oslo, Rikshospitalet, Norway. morten.harboe@labmed.uio.noNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15881032

Citation

Harboe, Morten, et al. "Challenges Presented By Nerve Damage in Leprosy." Leprosy Review, vol. 76, no. 1, 2005, pp. 5-13.
Harboe M, Aseffa A, Leekassa R. Challenges presented by nerve damage in leprosy. Lepr Rev. 2005;76(1):5-13.
Harboe, M., Aseffa, A., & Leekassa, R. (2005). Challenges presented by nerve damage in leprosy. Leprosy Review, 76(1), 5-13.
Harboe M, Aseffa A, Leekassa R. Challenges Presented By Nerve Damage in Leprosy. Lepr Rev. 2005;76(1):5-13. PubMed PMID: 15881032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenges presented by nerve damage in leprosy. AU - Harboe,Morten, AU - Aseffa,Abraham, AU - Leekassa,Ruth, PY - 2005/5/11/pubmed PY - 2005/6/10/medline PY - 2005/5/11/entrez SP - 5 EP - 13 JF - Leprosy review JO - Lepr Rev VL - 76 IS - 1 N2 - The basis of nerve damage in leprosy is the unique tendency of Mycobacterium leprae to invade Schwann cells. alphaBeta-Dystroglycan on the basement membrane of Schwann cells binds to laminin alpha2, in turn binding to receptors on the M. leprae surface, comprising a histone-like protein and phenoglycolipid-1. When nerve damage during reversal reactions was found to be associated with an abrupt increase in delayed type hypersensitivity against M. leprae antigenic determinants released from Schwann cells, it suggested that the nerve is damaged as an innocent bystander during the immune response. This strongly influenced the introduction of therapy based on immunosuppression combined with continued anti-mycobacterial medication. Lysis of Schwann cells presenting M. leprae antigenic determinants by activated CD4+ T cells and interaction of M. leprae with Toll-like receptors on Schwann cells are additional mechanisms implicated in nerve damage. Persistence of M. leprae antigen in local lesions after regular multiple drug therapy (MDT) is an important risk factor for late reactions. In spite of significant advances in the provision of MDT globally, early diagnosis, together with effective treatment of the disease and associated nerve damage at initial presentation remains a major challenge for the health services. Reduced prevalence as a result of MDT should not be taken to indicate that the challenges of leprosy control are diminished as long as nerve damage is not controlled and new case detection rates are not declining. SN - 0305-7518 UR - https://www.unboundmedicine.com/medline/citation/15881032/Challenges_presented_by_nerve_damage_in_leprosy_ L2 - https://medlineplus.gov/mycobacterialinfections.html DB - PRIME DP - Unbound Medicine ER -